GOAL: To implement, evaluate, and refine an innovative and interdisciplinary, simulation-based training model designed to improve teamwork and patient safety in operating room (OR) environments. AIMS: Consistent with the AHRQ mission, the project will enhance the quality, safety, efficiency, and effectiveness of health care for all American citizens through three project aims: 1) assess the efficacy of the System for Teamwork Effectiveness and Patient Safety (STEPS) as a mobile simulation-based strategy that takes training to professionals in their work setting; 2) assess the extent to which STEPS, as a comprehensive simulation and change process strategy, can positively impact teamwork and a culture of patient safety in the OR setting; and 3) enhance understandings of individual and organizational features that influence transfer of learning to on-the-job team performance and culture of patient safety. METHODS AND RESEARCH DESIGN: In Year 1, all OR team members at a large, public hospital will participate in the STEPS program. In Year 2, data will continue to be collected at the hospital where training was completed in Year and all OR team members at another similar hospital will participate in the STEPS program. A third hospital will serve as a control site for the two-year project period. A mixed methods research design will be used to address primary research questions that are based on the aims stated above. The quantitative component includes a two-group (treatment and control) quasi-experimental design for each of the two project years. Repeated measures using a competency-based 360-degree assessment in the actual OR setting and a questionnaire targeting attributes of a culture of patient safety will provide data for various analyses (e.g., ANCOVA). The qualitative component includes a case study design and periodic individual and group interviews, direct observation, and participant-observation. RELEVANCE: Effective teamwork and a focus on patient safety are critical public health, especially for citizens who are among the uninsured and disadvantaged that depend on public health care provider organizations. Simulation-based training provides opportunities for learning and deliberate practice without compromising patient comfort and quality of services. The potential for training effectiveness is maximized by using change strategies with stakeholders in their own hospital settings to facilitate individual and organizational adjustments and transfer of new knowledge skills, and attitudes to everyday practice. [unreadable] [unreadable] [unreadable]